Interventions

Question 1

Posterior vs anterior urethral injury

Answer 1

Posterior = membranous (pelvic fracture), surgery
Anterior = bulbar (straddle injury), may temporize with catheterization

Question 2

Cholecystectomy

Answer 2

No symptoms - no tx needed
Bilary colic - elective lap chole, may ursodeoxycholic acid to temporize
Complicated dz with cholecystitis, choledocholithiasis, or pancreatitis - cholecystectomy within 72 hrs

Question 3

Vascular surgery side effects

Answer 3

Cholesterol emboli (livedo reticularis, eosinophilia)
Toe ischemias, watershed areas of colon such as:
rectosigmoid junction with rectal sparing
splenic flexure
presents with leukocytosis, hematochezia, lactic acidosis
Endoscopy shows hemorrhagic, friable mucosa
CT scan wall edema and fat stranding

Question 4

SBO

Answer 4

Empiric abx with 3rd gen ceph such as cefotaxime
Fluoroquinolones for ppx
GNRs, SAAG > 1.1, protein <1, PMNs elevated

Question 5

Contraindications to hormonal contraception

Answer 5

Hypertension
migraines with aura
Smoking and over 35
DM with end organ damage
APL syndrome
hx of dvt, PE, stroke
breast cancer
heart or liver disease
major surgery
post-partum (< 3 weeks)

Question 6

Blunt abdominal trauma

Answer 6

FAST assessment
Hepatic, splenic laceration
Irritation of phrenic nerve may cause referred shoulder pain

Question 7

Emergency contraception

Answer 7

1 - Copper IUD
2 - Ulipristal pill
3 - Levonorgestrel pill
4 - OCPs

Question 8

Primary vs secondary Raynaud’s

Answer 8

Primary - treat symptomatically with CCBs
(young women, neg ANA)
Secondary - find etiology e.g. connective tissue dz, nicotine, vascular dz, sympathomimetics
(men > 40, digital ulcers)

Question 9

Torsades (polymorphic ventricular tachycardia)

Answer 9

Defibrillation if unstable
IV magnesium if stable
(due to prolonged QT, from meds or genetic causes)

Adenosine is reserved for SVTs
Avoid atropine, BBs

Question 10

MDD with psychotic features

Answer 10

ECT, esp if suicidal, elderly, or NPO

may add antipsychotic first otherwise

Question 11

Rhogam

Answer 11

to Rh - mothers at 28-32 weeks first, then:
within 72 hrs of Rh + infant delivery
after abortion, trauma, amniocentesis, or bleeds

Question 12

ADHD tx

Answer 12

Methylphenidate - if aversion to stimulants, atomoxetine (NE reuptake inhibitor)

Question 13

Lactose intolerance

Answer 13

Dx with positive hydrogen breath test

bloating, flatulence, cramps, diarrhea

Question 14

Cryptococcus meningitis

Answer 14

Dx with CSF labs (low gluc, high prot, crypto antigen)
Amphotericin B with flucytosine
maintenance with fluconazole
seen when CD4 < 100

Question 15

Variable vs late decelerations

Answer 15

Variable - oligohydramnios, cord prolapse, cord compression

Late - uteroplacental insufficiency

Question 16

HIT

Answer 16

Thrombocytopenia (>50% reduction) within 5 days of heparin exposure
Dx with serotonin release assay
replace heparin products with direct thrombin inhibitor or fondaparinux

Question 17

Bowel perforation

Answer 17

Air under diaphragm, pneumoperitoneum
Dx with x ray of chest/abdomen
Tx with surgery

Question 18

Tourette’s

Answer 18

Tx with 2nd gen antipsychotics, clonidine (alpha 2 adrenergic), behavioral therapy

Question 19

Psychotherapy

Answer 19

Supportive - low functioning, pts in crisis, psychosis
Cognitive behavioral - maladaptive behaviors
Interpersonal - depression
psychodynamic - high functioning, personality disorders
MIs - substance use
dialectical - Borderline personality disorder
Biofeedback - somatic or pain disorders

Question 20

Neonatal conjunctivitis

Answer 20

Chemical (following silver nitrate) - eye lubricant
Gonococcal (dx with cx) - IM cefotaxime single dose
Chlamydial (dx with PCR) - PO macrolide

Question 21

Vaginitis

Answer 21

Bacterial vaginosis - metronidazole or clindamycin
Trichomoniasis - metronidazole, treat partner
Candidiasis - fluconazole

Question 22

Labor protraction vs arrest

Answer 22

Protraction (cervical change +/- contractions) - oxytocyn

Arrest (no change > 4 hrs with contractions, > 6 hrs w/o contractions) - c section

Question 23

Pseudogout

Answer 23

Calcium pyrophosphate crystals deposits in joints and chondrocalcinosis
Send iron studies to r/o hemochromatosis
Also send TSH, PTH

Question 24

Hypertension in young patient

Answer 24

Send lipid panel, U/A, BMP, EKG first
Then rule out secondary causes:
Renal stenosis, coarctation of aorta, adrenal tumor

Question 25

Painless jaundice

Answer 25

Abdominal U/S or CT scan to r/o cancer in head of pancreas
Double duct sign - compression of pancreatic duct and common bile duct
Courvoisier sign - distended nontender gallbladder with intra and extrahepatic biliary duct dilation
Trousseau syndrome - migratory thrombophlebitis